婴儿巨细胞病毒感染相关血液系统损害的临床特点

The clinical features of infantile cytomegalovirusinfection associated with Hematologic System

目的探讨婴儿巨细胞病毒(HCMV)感染相关血液系统损害的临床特点。方法对51例婴儿HCMV感染相关血液系统损害进行临床分析,统计血液系统损害疾病的种类、临床表现、治疗及预后。结果 HCMV感染与多种血液系统损害相关,本组51例患儿均出现外周血淋巴细胞比例增加(其中引起外周血白细胞总数升高8例);出现中性粒细胞计数和比例均减少41例,占80.2%(其中引起外周血白细胞总数减少18例);血小板减少性紫癜26例,占51.0%;自身免疫性溶血性贫血2例(其中1例为Evans综合征),占3.9%;全血细胞减少4例,占7.8%(其中噬血细胞综合征1例,占5.9%);单核细胞增多症样综合征3例,占5.9%;合并EBV混合感染引起单核细胞增多症样综合征1例;合并细菌感染17例;合并肺炎支原体感染6例;合并浅表真菌感染(鹅口疮)3例;合并转氨酶升高39例。治疗上应用更昔洛韦及纠正合并症,部分患儿同时给予丙种球蛋白、地塞米松及输注成分血等疗法,伴噬血细胞综合征加用HLH-2004方案治疗,均好转或痊愈出院。结论 HCMV感染可致多种血液系统损害,其中白细胞改变最突出,80.2%患儿出现中性粒细胞减少、100%患儿淋巴细胞比例升高;其次51.0%患儿出现血小板减少;也可引起严重的噬血细胞综合征。

Objective 51cases with HCMV infection were studied retrospectively. Methods Their clinical features, Species of,treatment and prognosis were statistically analyzed. HCMV infection can cause multiple hematological diseases. Results Among the total 51patients, all cases were found the the proportion of peripheral blood lymphocytes increased （8cases were found the peripheral blood leukocyte count were increased, 41 （80%） with neutropenia（ 18cases were found the peripheral blood leukocyte count were decreased ）, 4 （3. 9% ） two cases with autoimmune hemolytic anemia （one of them, Evans syndrome）, 4 （ 7.8% ） with pancytopenia （ one case with hemophagocytic syndrome ）, 3 （ 5. 9% ） with mononucleosis syndrome, there were 1 cases who developed Mononucleosis - like syndrome Combined EBV infection, 17cases combined with systemic bacterial infection, 6 cases combined with mycoplasma pneumoniae infection; 3cases combined with superficial fungal infection （thrush） , Among the total 51patients,39cases were found the transaminase increasesd. 39cases were treated with ganciclovir, some children were given gamma globulin, dexamethasone and infusion of blood components therapy, with hemophagocytic syndrome, were given to the HLH-2004 program, after treatment they all improved or discharged from hospital. Conclusions HCMV infection can cause a variety of damage to the Hematologic System, the changes of white blood cells were the most prominent, 80.2 % of children with neutropenia,100 % of children with increased lymphocyte ratio, the second, thrombocytopenia occurred in 51.0% children;some can also cause severe hemophagocytic syndrome.